Provider Demographics
NPI:1831068279
Name:SOURCE PELVIC HEALTH
Entity type:Organization
Organization Name:SOURCE PELVIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:HOLLY
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CSOT
Authorized Official - Phone:817-808-9550
Mailing Address - Street 1:PO BOX 110746
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0746
Mailing Address - Country:US
Mailing Address - Phone:817-808-9550
Mailing Address - Fax:
Practice Address - Street 1:6691 SHANGRI LA CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-5070
Practice Address - Country:US
Practice Address - Phone:817-808-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation